Celiac artery compression syndrome: Operative management and clinical outcomes following median arcuate ligament release a three-case series

Median Arcuate Ligament Syndrome (MALS) is a rare condition resulting from external compression of the celiac trunk by the median arcuate ligament. The clinical presentation is often nonspecific typically postprandial abdominal pain, nausea, vomiting, and weight loss leading to frequent diagnostic delays. CT angiography plays a pivotal role in identifying the characteristic celiac artery stenosis and post-stenotic dilatation.

We report three clinical cases: two young female patients and one 61-year-old male presenting with chronic abdominal pain and weight loss. CT angiography confirmed significant celiac trunk stenosis in all cases, with post-stenotic aneurysmal dilatation in two patients and collateral circulation in one. All underwent open surgical decompression through division of the median arcuate ligament.

Postoperative outcomes were favorable, with marked improvement in abdominal symptoms and progressive weight gain. Follow-up CT angiography demonstrated a fully patent celiac trunk without residual stenosis.

MALS is a challenging diagnostic entity requiring careful correlation between clinical manifestations and dynamic imaging findings. CT angiography remains essential for diagnosis and preoperative planning. Surgical decompression provides substantial symptomatic relief in appropriately selected patients. Larger prospective studies are needed to identify predictors of optimal postoperative outcomes